Surgery Day!!! Not... {Growl}

Happy Surgery Day to me! NOT.
Today at this time I should've been moaning in agonizing pain, but I'm not. I'm going about my normal day. Happy about the non-pain part... really pissed off about the non-surgery part. Oh well. Such is life. The doc obviously didn't care that I had changed my entire life and that of a whole part of a consulting company back east. It didn't matter that now I will be too swollen to attend my parents' 40th year anniversary party I am helping to throw or have family Christmas card pictures taken. He obviously didn't care that I had already begged and borrowed, turned in favors at work to get things learned and duties changed and time off granted. He didn't care that I had arranged for sitters and rides for the kids, and purchased the liquids for my new diet or the handy waterpik I was going to be relying on to clean my banded-shut mouth. It didn't matter to him that I had paid extra bills in advance thus making us scrape by -and of course it happened during a week when our youngest dog needed costly surgery and then found out it was cancer. Nope. They had "scheduled two surgeries on the same date at different facilities"...and he "couldn't facility hop". Really? Really? I personally believe there's more to the story. My surgery had been scheduled for 3 weeks now and it took them until 5 days before my surgery to figure that out? I had just called the day before to verify the hospital knew I was coming too because I knew they didn't. I work here. I know these things. I had called down to pre-registration. I know my reponsibilities. I knew they'd have the info. But they'd never heard of it. I personally think they never called to schedule the surgery and then realized he couldn't do it. Then and only then did they also decide to call and tell me it's moved and use the excuse of the authorization not being approved for the nasal part of the surgery. Not that I didn't already tell them I was fine with that and would rather not have the nasal surgery if it wasn't approved. I know how auths work. It's not gonna happen...regardless of how they beg in a peer-to-peer review or change the medical records. Blech. I'm just mad. I now have an entire month to continue to sit and stew about this and to get myself worked up into even more of a panic attack. I'm sure I'll end up with a stress induced cold sore. Lovely...
So now I can pretend to be positive about the change of date: I can be glad the date has changed for a few reasons. First of all I will be around for K's first week of school and before school testing. That's a real good thing. I can get my hair colored before surgery now since my hair lady was on vacation before. I am able to become more fluent in the new system at work...even though I'd rather I didn't and don't think I'd be missing much if not. I can go swimming with my boys a couple more times for the summer. I can still eat whatever I want. There. I feel a little less negative. Still really pissed off though...but at least I can say I tried to turn it around. Haha.

5 days before surgery

I'm in pure panic mode about the upcoming surgery. I have only 5 more days left to do so many things but I have rearranged my life for this and it's happening...well...
Nope, just kidding...it's not.
The boys and I had to run our lab mix to the vet for a surgery to get a large mass removed from his thyroid and my cellphone rings. It was Dr S's head secretary, Lauree. She's the one all the young little receptionists have to ask all their questions to. As soon as I heard her tone of voice I knew there was a problem. Lauree proceeds to tell me that the doctor has had another surgery scheduled longer than mine and its at another facility and he can't 'facility hop' the day of my surgery. I think to myself, 'OK, so it'll change a day or two...no biggie'. Then she continues to say that he feels strongly that I still have the nasal septum repair and turbinate surgery that my insurance company has denied as not medically necessary so he's continuing to appeal that denial. Then comes the date. September 18th. Oh. My. God. Anger cannot even begin to describe my feelings. I have literally put my life on hold for this. I have my leave of absence papers filed and approved at work, my actual work duties covered, babysitters arranged, hubby took off work, I've paid a whole bunch of bills early that would've been due when I was off and low on money- in turn putting us in a bit of a pinch for a couple weeks, and lastly had the consulting company that is working with our company schedule their next visit (from out of the state!- so airfare/hotels/etc) for when I would have returned from surgery - but now for when I will be gone. I'm beyond pissed off. Livid would be a better description.
Well, I guess I will make the most of this. I guess its good that the insurance authorization will be approved (hopefully) so I can have the entire surgery. I guess its good that I will be OK for K's first week of school. Now I can go to all the restaurants I've been wanting to eat at before I can't chew for months. I can learn the new system at work better before going out on leave. Its OK...right? Sigh. I guess it has to be, I have no choice.

Week before surgery

Well, with less than a week until surgery day I'm about ready to have a complete and utter panic attack. I'm so scared! I've had many surgeries, I've never been this scared for a surgery or any procedure in my life... even my kids' surgeries weren't as scary! I keep reading through all the blogs and patient experiences I can find and the phrase "life changing" is said pretty much every time. I'm literally praying for that! I need it to be. I need my life back. I need energy, less pain, less meds! I know this will lower my risks of a stroke or a heart attack. I know my organs have been deprived of oxygen for so long that they are in desperate need of help. These are all the reasons I'm putting my face on the chopping block, so to speak. I'm hoping to drastically reduce or even cut out my naps that I require I'm not working. My kids are growing up and napping while they're napping is no longer feasible. LOL! I want to be the mom who is *happily* awake in the morning with her kids while they get ready for the day....not the one that they as a toddler and kindergartner get themselves fed and watch tv while mom sleeps in till 9am. I want to wake up without a headache or even worse a migraine! I want to wake up refreshed...not in a state of confusion and achy. These are the reasons I decided to do this. Well, that and the two doctors recommendations that no surgery less than this would help my severity of sleep apnea.

Molds, CT Scan & Family Appointment

I had one last appointment to go to before my surgery today. I had to go in for my molds, a CT scan of my jaw and a pre-surgical split. I had DH come to help out with the boys as well as to hear it 'from the horses mouth' just how actually horrible the surgery is. I wanted him to hear the details and recovery info from the doctor before the actual surgery so he knew what we were getting into. I needed him to understand just how major a surgery it is. It was ironic really, because one of the papers I had to sign said as much. Paper signed and everything worked out through the office and all 4 of us went back to the room. The doc came in to talk to us and tell DH just what I hoped he would and to look at my mouth one last time. He answered some questions and then I was left with the nurse. She pulled me into the next exam room away from the may-lay that is my family to do the molds. We had to do two sets. I was so scared of it because I'm so claustrophobic but she went fast and I did OK. I guess the reason they do two molds is because one has to be sent to the manufacturer before surgery and then the doctor likes to have one to perform a mock surgery on. That made me feel much more confident. After doing the molds I was done. We were out of there. I just had to have the LOA papers for work signed and that would be the last time I saw anyone in that office again with the current face and jaw I have. The office staff filled out my papers with a 2 week leave after talking with the doc. He was hesitant to only let me off 2 weeks but after I said I'd be able to work from home the 3rd week he backed down with a "as long as you realize you can have more time if needed". Yea, yea, yea...I thought, I'm a quick recover-er, and I had stuff to do! I also asked the office staff for the CPT and ICD-9 codes for the surgery I was about to have so I could do a little insurance investigation of my own. Just for anyone's reference that cares, they are:

Dx codes- 327.23 Obstructive Sleep Apnea, 524.03 Maxillary Hypoplasia, 524.04 Manibular Hypoplasia, 524.12 Other jaw asymmetry

CPT codes- 21141 LeFort; single piece without graft, 21196 Bilateral Sagittal Split, 21199 Genioglossus, 30520 Septoplasty, 30130 Turbinectomy, 21085 Surgical Splint- to be done 2 weeks prior to surgery.

When I got home that afternoon I IM'd my boss to tell him the news and date. I apologized profusely for the timing but we agreed it'd be OK. Phew. Thank God! Now, to hurry and finish my quarter at work and learn a new system all in a 3 week period! Sigh...

Pictures of up my nose

It'd been a couple weeks since my initial appointment with Dr. S and I was still waiting for my insurance company to get the authorization underway. I had called every other day for  the last 10 days with no information. I had decided to just give up. Then after just getting to work, my cellphone rang. It was Dr. S's office calling to say they have scheduled my surgery and I needed to come in for a few more pictures and to sign papers. Yikes?! It was getting real! Natasha from the doctors office informed me that they hadn't received the authorization from my insurance yet but where not worried as they usually have no problems. That made me feel a little calmer. She then said that they would probably need more pictures for the authorization so I needed to come in as soon as possible. I needed to run home on my lunch break anyway so it was no problem to add one more stop. Then she told me the date. Wednesday August 21st. Holy shit! No, I thought to myself. I can't do it that soon. I have training at work on a new system, it was K's first week of school, I had stuff going on that I could not be out of commission for. But, I guess my schedule meant nothing and it was when the doc and the assistant surgeon could be together. I reluctantly agreed to the date, said I'd be in the office for my pictures at noon and hung up the phone. The first thought through my brain, "OMG (my boss) is gonna kill me." We had this training at work literally in the making for 18 months. There was a lot I needed to be there for. I wasn't about to rely on my coworkers to reteach me the new system when I got back. I didn't trust them to mostly, but I also knew they wouldn't have time since we were already so behind. I had purposely not told anyone about the surgery before because I kind of thought it was a long shot on the insurance authorizing it... or me even doing it. But it had just become real. I had to fess up. I immediately sent in my request for a LOA. I didn't know exactly how long I'd be out but I knew it was going to be longer than a few days and I'd need to be official about it. I'd get all the info at the doctor that afternoon, I thought to myself.
I arrived at Dr. S's office about 12:30pm after running to my house first. They were always so nice there and I still felt like a rich person coming in for a nose job and a day spa appointment there. But, alas my problem wasn't so luxurious. Its an actual medical problem. Natasha pulled me into a room and we bent in strange positions to get the pictures up my nose and from above to prove that I wasn't indeed just getting a nose job to fix a bent nose for the insurance company. That's all I had to do. I then asked about how long I'd be out of work. She said "a few weeks" but said to ask the doctor at my next appointment. I made an appointment for the following Monday and was out the door. I was going to have to break it to (my boss) soon, I guess.

The consultation

It was a blistering day in July when I had my first consultation with Dr. 'S', DDS, MD, Board Certified Oral and Maxillofacial surgeon. I dropped my boys off at the sitter and made it to my x-ray appointment the half hour before on time. It was easy enough. Just smile big for the camera while it rotates around my head and takes pictures of every angle of my jaw and head. In and out in under 15 minutes. Then down the street I went to the actual doctor appointment. I pulled into the parking lot and somehow missed the huge visible sign stating which building I was to go to and walked into the building across the way. It was hot, like over a hundred...and I was exhausted, as usual, from lack of sleep but this guy was supposed to help... at least according to my sleep doctor. I finally realize I'm an idiot and got into the right office building. Dr. S's office is amazingly beautiful...like a day spa. I immediately wondered whether this visit would even be covered under my medical insurance because I felt like it was considered cosmetic. Of course, that was the medical insurance background personality of me thinking...I needed to remind myself I had a legitimate medical condition- Sleep Apnea. Big time Sleep Apnea. I stopped breathing somewhere around 80x an hour. I don't know the specifics but I was led to believe this was a lot... even "severe". They told me my 'sats' but I don't remember those. Anyway, I digress... After checking in with the nice receptionist and signing (electronically, of course) all the necessary forms that I had already filled out online I sat down. There was a TV screen with a video of the good doctor on the wall talking about some procedure as well as other patients giving their recommendations. I felt sort of like I was in an infomercial, but if these people weren't actually paid actors I guess it was comforting. My name was called and I went back to my room. It was a very plain room with a dentist looking chair and some cabinets, a single chair and sink. The nurse informed me that I get to be in a "photo shoot" first. A zillion excuses start running through my brain. I hate cameras. I hate pictures of myself. I didn't put any make-up on...'er...I did, but it just melted off. But I guess it was for the doctor and insurance so I had to do it. She took side shots - of which who really looks good in that profile? - front shots, head shots, shots with me holding some stuff in my cheeks pulling my mouth open for my bite...it was embarrassing, but I did it with a smile. She then proceeded to tell me she 'has to inform me of the risks of the surgery'. I think to myself, "Um, I haven't even said I *want* the surgery yet, or even knew exactly what the name of the surgery was...much less talked to the doctor...why are you telling me this?" But, I let her ramble. And that she did. Ramble, on and on. Risks a-plenty! Shiest! I'm in trouble. I had already read some blogs, done my research and had a pretty good idea what to expect but hearing it firsthand was a little frightening. Here they are, now you can freak out too:

• Pain and swelling can last as long as 6 months
• Facial appearance changes 
• Numbness of the lower lip and chin for months, but can be permanent for some people.
• May need corrective braces for teeth or jaw if teeth are not aligned correctly after surgery.
• Weight loss. Due to the liquid diet for up to 6 weeks. (this one isn't bad but is gonna suck)
• Can affect TMJ (which my ENT seems to think I have, but the oral surgeon does not so who knows...)
• General surgery complications: Anesthesia side effects, breathing difficulty, loss of blood, stroke, heart attack, etc.

The good things and info about this surgery though are: 

• This is the only procedure that serves as the most effective treatment for severe OSA - and - it's 95% successful! Other OSA surgeries are below 50%.
• It is only for patients how have moderate to severe OSA who have also failed one or multiple basic methods of treatment. (CPAP- I rip it off in my sleep due to being so claustrophobic, Weight loss surgery - Yea, right! I wish I could get it paid for. Nasal surgery along with tonsils - Wouldn't even make a dent in my apnea and I'd still have to wear a CPAP mask)
• The jaws do not need to be wired shut anymore, they are just banded. However, its pretty much the same endgame.

So, the risks/rewards/info section with the nurse section was done, now it was time to meet the doctor and see what he has to say. Nutshell? He said, Hell Yes. 'You meet every single criteria for this surgery' is what he said. Let's get it done. I agreed, half heartily and left the room. Off I go to the insurance ladies to start the paperwork for the preauthorization. Working for the company that provided my insurance benefits I had a feeling this was going to take a long time and be one of those surgeries they deny as 'experimental/investigational' or not medically necessary. I was told she had all she needed and would send the paperwork to my insurance to get the authorization done. I was out the door... and Freaking Out!

PreSurgery

PostSurgery

The photos above where taken from the website below. It's a great reference and blog of one of the first surgeons in the LA area to have done this surgery. He's got lots of patient experiences that helped me to understand a bit of what to expect:  http://www.sleepapneasurgery.com/max_advance_exp.html